AB1414 PREDICTIVE FACTORS OF BIOLOGIC DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (BDMARD) USE IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS
Authors: A. Martins, S. Ganhão, F. Oliveira Pinheiro, C. Morais, M. Leuzinger-Dias, M. Rodrigues, L. Figueira, I. Brito
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The advent of disease-modifying antirheumatic drugs (DMARDs), in the past two decades has been revolutionary in the treatment and prognostic outcomes of patients with Juvenile Idiopathic Arthritis (JIA). Since some patients have inadequate responses to conventional DMARDs, biologic DMARDs (bDMARDs) must be prescribed to guarantee the achievement of complete remission. Early and appropriate treatment can prevent joint destruction, loss of joint function and extraarticular manifestations, with subsequent less morbidity and mortality. <h3>Objectives</h3> To identify the JIA patients with a higher probability of requiring treatment with bDMARDs and to investigate the predictive factors. <h3>Methods</h3> A retrospective single-center study of patients with JIA followed in a tertiary Hospital was conducted. Sociodemographic, clinical, laboratory and treatment characteristics were collected from Portuguese Rheumatic Diseases Register and medical records. Statistic was performed with independent samples t-test, Mann-Whitney U test, chi-square test and Fisher's exact test. Statistical significance was set up at a p-value &lt;0.05. A multivariate logistic regression analysis was performed to identify possible predictive factors for bDMARD use. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. <h3>Results</h3> A total of 165 patients with JIA (107 females, 64.8%) were included. Seventy-five patients had oligoarthritis (45.6%, 62 had persistent oligoarthritis and 13 had extended oligoarthritis), 17 psoriatic arthritis (10.3%), 30 rheumatoid factor (RF)-negative polyarthritis (18.1%), 6 RF-positive polyarthritis (3.6%), 14 systemic arthritis (8.5%) and 23 enthesitis related arthritis-juvenile spondyloarthritis (13.9%). Fourty-five patients were treated with bDMARD (27.3%). Males were treated more frequently with bDMARDs than females (p=0.058). Regarding JIA subtype, more RF-positive polyarthritis patients needed bDMARDs to achieve remission (p=0.027). Likewise, concerning disease activity, JIA patients with higher C-reactive protein (CRP) values were more frequent treated with bDMARDs (p=0.032), which was not verified for erythrocyte sedimentation rate (ESR). Uveitis was significantly more frequent in the bDMARD group (p=0.006). Moreover, more patients with bilateral involvement were treated with bDMARDs, compared with patients with unilateral uveitis (n=0.032). Nevertheless, no differences were found concerning age and number of joints involved at onset, disease duration and ANA positivity. In a multivariate regression model adjusted for gender, the presence of uveitis (OR 4.42, 95% CI 1.43 to 13.60, p=0.010) and polyarticular involvement (OR 6.62, 95% CI 2.05-21.43, p=0.002) remained statistically significant predictive factors for bDMARD use in patients with JIA. <h3>Conclusion</h3> Male patients, polyarticular involvement (with negative or positive RF) and bilateral uveitis were more frequently treated with bDMARDs. In addition, CRP values at onset of JIA were higher in the bDMARD group. Thereby, the presence of uveitis and polyarticular involvement seem to predict the need of bDMARD treatment in JIA patients. Prompt treatment with these agents, early in the disease course, especially in JIA patients with more articular involvement and extraarticular manifestations like uveitis, refractory to conventional DMARDs, should be strongly recommended, in order to avoid irreversible damage and to achieve complete and long-term remission. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.